PROJECT SUMMARY Upon diagnosis of hearing loss, parents/caregivers of children who are deaf/hard-of-hearing (DHH) make decisions around numerous approaches to language and communication development. Despite strong efforts to improve long-term outcomes, DHH children continue to fall short of age-appropriate language levels, placing them at risk for reduced academic achievement, behavioral problems, and poor social abilities that persist into adulthood. The lack of research supporting innovative intervention strategies leaves a gaping hole in our ability to fully support DHH children. Thus, we are unable to provide families with the quality information regarding intervention options. Evidence supports augmentative and alternative communication (AAC) for enhancing language development, yet technology-based AAC has not been applied or effectively studied in DHH children. To address the substantial and pervasive language deficits among DHH children that have persisted despite advances in amplification technology and early identification, we designed a technology-assisted language intervention (TALI) that incorporates high-tech AAC into speech-language therapy as a language teaching tool specifically adapted for DHH children. Our central hypothesis is that DHH children who participate in the TALI will have greater gains in spoken language outcomes compared to DHH children who receive treatment-as-usual (TAU) speech-language therapy. In a small randomized trial to test the effectiveness of the TALI, our preliminary data show that the TALI significantly improves spoken language outcomes for DHH children and is more effective than TAU. However, there remains a need to (a) provide evidence for reproducibility and generalizability in a larger population and (b) understand the TALI effectiveness on additional language outcome measures. We propose a randomized controlled trial of 114 DHH children at 2 recruitment sites (Cincinnati Children?s Hospital Medical Center and Children?s Hospital of Colorado). Children will be randomized to either receive 24 weeks of the TALI or 24 weeks TAU therapy. We will expand our current work to include additional language outcomes, creating a more complete picture of the effectiveness of the proposed intervention. We will test our central hypothesis through the following specific aims: (1) Compare spoken (expressive) language outcomes in DHH children and participating in the TALI with those participating in TAU therapy; (2) Compare language outcomes measured on standardized assessments between children who are DHH participating in the TALI with those participating in TAU; (3) Evaluate whether the benefits of the TALI on language outcomes is maintained 6 months post-intervention. Primary outcomes include syntax, semantics and discourse collected from language samples measured every 6 weeks and receptive/expressive standardized language scores measured pre and post intervention. AAC use will be monitored to measure adherence to the TALI while at home. This project directly aligns with NIDCD?s strategic plan?s overarching goal of improving outcomes in human communication.